A horrifying and little-known practice known as “bluetoothing” — in which one person injects drug-tainted blood drawn from another user — is emerging as a potent driver in the world’s fastest-growing HIV epidemics. Experts warn that while the technique is rare, its speed and efficiency in transmitting HIV and other bloodborne diseases demand urgent action from public health systems worldwide.
Bluetoothing (sometimes called “hotspotting” or, in East Africa, “flashblood”) is a gruesome twist on needle sharing. A drug user injects a dose of heroin, methamphetamine, or similar substances, then draws back some of their own blood — now infused with the drug — and passes it via syringe into another person. That person may repeat the sequence, passing blood further down the chain.
Though the method sounds almost beyond belief, field reports and epidemiological investigations confirm its existence in high-poverty and high-risk communities. Even though only a small fraction of injecting drug users may engage in it, bluetoothing’s transmission dynamics make it far more dangerous than typical needle sharing.
In regions rife with limited access to clean syringes, aggressive policing of drug paraphernalia, escalating drug prices, and dwindling supply, users sometimes see blood sharing as a low-cost shortcut to a high. But public health experts caution that what may be cheap in money is incredibly expensive in lives.
Fiji has become a tragic proving ground for bluetoothing’s destructive potential. In the decade between 2014 and 2024, the number of new HIV infections surged tenfold — a resurgence significant enough for authorities to formally declare an HIV outbreak in January 2025. In 2024, roughly half of newly diagnosed patients receiving antiretroviral therapy reported contracting HIV via needle sharing, though public health agencies concede they cannot reliably distinguish which cases specifically involved blood sharing. The jump in infections has zeroed in on younger demographics — those ages 15 to 34 — putting an entire generation at risk.
Frontline workers describe horrifying scenes. Kalesi Volatabu, director of the NGO Drug Free Fiji, recalls walking in Suva one morning and stumbling upon a group of people lined up, a syringe passed between them, as one individual withdrew blood and handed it to another. “It was right there in front of me,” she said. “This young woman had already had the shot … and then you saw others lining up for theirs.”
Public health officials stress that bluetoothing is only one element in a toxic mix that includes needle sharing, unprotected sex, and inadequate harm reduction resources such as clean-needle programs and education. “We’re seeing young kids dying from HIV — children who’ve been involved in drug use and sex,” said Eamonn Murphy, director of UNAIDS regional support teams.
Yet the method is self-defeating in terms of drug effect: experts note that by the time the drug is dispersed through blood and diluted, its potency is greatly diminished. Some say any “high” is largely psychosomatic. “It’s not nearly as effective as people were hoping,” Murphy said. “Further down the chain of injecting, there’s much less of a buzz.”
Still, when syringes are scarce and desperation high, users sometimes opt for risk. In Fiji, pharmacies have come under pressure to restrict syringe access — demanding prescriptions or refusing sale — and needle-syringe exchange programs remain extremely limited. To combat the crisis, Fiji’s Ministry of Health has instituted a 90-day plan: increasing HIV testing and treatment, expanding awareness campaigns, and rolling out condoms and clean-needle access points. But observers caution the response may be too little, too late, especially for unseen or untested infections.
Though Fiji has become the flashpoint, bluetoothing is not uniquely Pacific. In South Africa, Tanzania, Pakistan, and other high-HIV burden areas, public health teams have reported evidence of blood sharing among injecting drug users. In South Africa’s townships, for example, users of the street drug “nyaope” have adapted bluetoothing techniques. One user described injecting his friend, then immediately withdrawing and injecting the friend’s blood back into himself. “I’ve just bluetoothed, eh,” he said, acknowledging a grim casualness over the danger.
One study in South Africa found that 18 percent of sampled injecting drug users admitted to using blood sharing. That represents a substantial subpopulation exposed to extreme risk. In Tanzania, bluetoothing — often termed “flashblooding” — migrated from inner cities into suburbs, disproportionately affecting women in unstable housing. In Pakistan, another variant has arisen: users selling partially used, blood-infused syringes as quasi–drug vials.
The drivers across these regions echo those in Fiji: poverty, policing that restricts safe supply of syringes, rising drug prices, shrinking drug availability, and overlapping vulnerabilities such as unstable housing, lack of education, and social stigma. “The real challenge will be dealing with the introduction of harm reduction programs,” Murphy noted, especially in socially conservative settings where drug use is heavily stigmatized.
Even though the volumes of blood exchanged in bluetoothing may be small, the risks are extremely high. Mixing blood from different users without screening is a direct conduit for HIV, hepatitis B, hepatitis C, and other pathogens. Because blood sharing delivers pathogens deeper into the circulatory system, fewer viral particles are needed to establish infection than in many needle-sharing events.
Brian Zanoni, a researcher at Emory University, calls the practice “underexplored but super high-risk.” He warns that a single drop of contaminated blood can carry tens of thousands of viral particles. Catherine Cook, executive director of Harm Reduction International, describes bluetoothing as “the perfect way of spreading HIV … a wake-up call for health systems and governments.”
Beyond virus transmission, mixing incompatible blood types can trigger severe adverse reactions — even in the absence of infection — including hemolysis, allergic reactions, or vascular complications. Thus, bluetoothing presents not only epidemiologic risk but acute medical danger in each exchange.
Bluetoothing may be underreported, but public health experts argue that waiting for perfect data is dangerous. The high infectivity, rapid chain potential, and ability to seed outbreaks in vulnerable communities require preemptive responses. Key strategies suggested include rapid expansion of needle and syringe exchange programs, peer education, decriminalization of syringe possession, broader HIV screening, and integrated services for addiction and disease prevention.
In Fiji and comparable settings, stigma around drug use continues to stifle intervention rollout. Many communities resist policies such as needle exchange due to moral opposition or fear it will encourage drug use. But communities already bearing the brunt of HIV cannot afford such moralistic delays.
While the true prevalence of bluetoothing remains poorly quantified, its appearance in multiple high-risk zones — and its clear role in accelerating HIV outbreaks — should galvanize health authorities globally. Even if only a few users are engaging in it, the potential for rapid propagation is high enough to demand an urgent, coordinated response.
As global attention zeroes in on outbreaks like the one in Fiji, the lesson is clear: new and unexpected vectors of transmission can emerge in the shadows of addiction and inequity. Bluetoothing is a cruel reminder that when societies neglect harm reduction, desperate people will invent ever more dangerous shortcuts — and diseases like HIV will exploit them ruthlessly. Governments, NGOs, and health systems now face a stark choice: act decisively to avert further devastation — or be held accountable for the costs of silence.
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